As a doctor, I’m unfazed by most medical issues. When my son went through a routine outpatient procedure, the last thing I expected was to feel worried. But even I found it disconcerting when complications led me to contact the surgeon on call, only to be told that my son was “probably fine.” For the surgeon, it must have seemed like business as usual, but for my son and me, it was a discouraging start to the recovery journey. The experience impressed upon me an important truth: While medical professionals may be diligent about providing information to the patients they discharge, they’re not paying nearly enough attention to the kind of support these individuals will need once they get home.
Discharged—and on your own
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Dr. Alan Spiro Dr. Alan Spiro is a leader in healthcare delivery and management, with more than 40 years of clinical, analytics, marketing, management and operational experience. He is currently the President and Chief Medical Officer of Laguna Health, a digital-first recovery platform. He most recently served as a clinical advisor and fractional Chief Medical […]
Each year, 35 million people are admitted to hospitals in the United States, and at least two-thirds of them are discharged to self-care at home. Like my son, many of these individuals experience pain, mental fog, medication side-effects, and emotional trauma following their inpatient or outpatient procedure. All too often, they are left on their own to navigate these challenges, and many struggle to do so. As a result, almost 20 percent of home-discharged patients are readmitted to the hospital, and more than a third transition to higher cost settings. Recovery doesn’t just take a toll on the patient; it’s a drain on the entire healthcare system.
My experiences both as a physician, and as a patient and caretaker, offer insight into why patients can feel abandoned once they leave the hospital. On one hand, as I made home nutritional support visits to patients as part of my gastroenterology and nutrition practice, I was impressed at how competently patients and their families could handle the complex instructions they received. But on the other hand, I was often struck by the fact that these instructions were given without regard to the life context of the people having to follow the instructions.
We take it for granted that when we have even a simple outpatient procedure like a colonoscopy or an endoscopy, we’ll need someone else to take us home. After all, anesthesia can have lingering effects, among them amnesia. But if you’re not lucid enough to drive yourself home, are you really able to understand the self-care instructions you’re given on the way out the hospital door? How well will you be able to follow that protocol once you’re home? What questions will come up in your mind once the fog begins to lift, and who will be around to answer them?
Treatment and aftercare get separated
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The trend to discharge patients sooner, and to perform even invasive procedures on an outpatient basis, is part of the larger trend to drive down costs under managed care. In essence, hospitals serve patients as both a treatment facility and a (costly, not particularly nice) hotel. If you’re trying to minimize cost and maximize care, you’ll focus on the former rather than the latter, and get people out of the hospital as soon as reasonably possible. That makes sense in a vacuum, but it fails to take into account the nature of the recovery process, and the kind of support it requires in any setting.
Meanwhile, we’ve seen a concurrent cultural shift within the medical profession from taking ownership and responsibility for each individual patient—taking their calls, visiting them at home if needed—to acting more as shift workers. The physicians and nurses still care, but are criticized for being inefficient if they take on tasks that are “not at the top of their license.” If you’re in primary care, you stay in your office rather than visiting your patient in the hospital. If you’re a hospitalist, your relationship with the patient rarely extends beyond the walls of that facility. This separation of treatment from aftercare makes a seamless recovery journey far more difficult to achieve.
Bridging the gap with technology
Repairing the recovery journey isn’t as simple as turning back the clock to the days of house calls. Physicians today are simply too costly and too specialized to take ownership of the caring function. But technology tools, in particular analytics, can help hospitals understand which patients are most likely to need support, and the type of support they’ll need, so that it can be provided in a more efficient and cost-effective way.
The factors that can signal a need for support are as likely to be cultural, emotional, or logistical as medical. If a recovering patient is a new parent, will they be more focused on being gentle with their baby at the expense of their own wound? Will a person who just had leg surgery be returning to a house where the bedroom and bathroom are on separate floors? Often, the best clues can come from a patient’s subjective experience of their own recovery. If you ask someone each day how well their recovery is going, any growing uncertainty they express can signal a need for further questions and investigation. Technology can make this kind of daily reassessment feasible, helping doctors identify who they should re-engage and work more closely with. With the help of artificial intelligence, cases can be escalated and routed accurately to ensure that the right support is given in the right way, by the right practitioners, to the right patients.
This approach offers clear incentives for every member of the care ecosystem. Hospitals can improve long-term patient outcomes. Payers can keep costs down by reducing readmissions; better, more comprehensive care support can also lead employees to feel that they’re receiving higher-quality benefits from their employer. And for patients, of course, a better supported recovery journey can greatly ease the anxiety, discomfort, and distress that can follow any kind of procedure.
Having a trusted friend or family member on hand to take you home after a procedure is critically important—but that shouldn’t be the full extent of the support you receive. By creating a focused approach to the transition to the home and often prolonged recovery journey, while taking each person’s life context into account, we can make sure that no patient feels abandoned by the health care system once they leave the hospital.
Photo: PeopleImages, Getty Images
Dr. Alan Spiro is a leader in healthcare delivery and management, with more than 40 years of clinical, analytics, marketing, management and operational experience. He is currently the President and Chief Medical Officer of Laguna Health, a digital-first recovery platform. He most recently served as a clinical advisor and fractional Chief Medical Officer for several early and growth stage healthcare companies, and was formerly SVP of Strategy and Analytics and Chief Medical Officer for Blue Health Intelligence. Prior to Blue Health Intelligence, Dr. Spiro held brief Chief Medical Officer role at Medica, and is most well-known as the co-founder and Chief Medical Officer of Accolade, an on-demand healthcare concierge for employers, health plans, and health systems.
